Abstract
This mixed-methods study explored the impact of community-based arts programming on psychosocial outcomes associated with trauma recovery among adults with low-to-no-income engaged in active recovery from homelessness, domestic abuse, substance use, and other forms of trauma. Conducted in partnership with Path with Art, the study assessed mental well-being, social connectedness, and self-efficacy using validated pre- and post-intervention surveys alongside qualitative exit-surveys. Participants (N = 80) demonstrated statistically significant improvements in mental well-being (p < .01), loneliness (p < .01), and self-efficacy (p = .02), following participation in 8-week community-based arts classes. Analysis of qualitative responses (N = 103) revealed five interconnected themes: social connection and community; mental and emotional well-being; personal growth and empowerment; motivation and purpose; and creative and educational engagement. Participants reported feeling less isolated, more confident and motivated, and described the arts as a meaningful tool for navigating challenges related to trauma recovery. The findings suggest community-based arts engagement supports psychosocial processes central to trauma recovery. While limitations such as self-selection bias and lack of a control group should be addressed in future research, the study contributes to growing evidence that arts programming can positively influence health outcomes in trauma-affected populations. These insights may inform public health strategies and community-based care models focused on recovery and resilience.
Keywords
Background
This study builds upon an existing body of research highlighting the role of the arts in supporting health and well-being. Engagement in arts and cultural activities has been associated with improvements in psychological, physical, and social dimensions of health, with benefits observed from adolescence through older adulthood (Fancourt et al., 2023; Fancourt & Finn, 2019; Pesata et al., 2022). It is also increasingly being recognized as a health behavior (Rodriguez et al., 2024). Evidence synthesized by Fancourt and Finn (2019) suggests that arts engagement can support disease management and treatment, as well as contribute to broader health prevention and promotion practices. By addressing these interconnected dimensions of health, the arts offer a holistic approach to well-being.
Among trauma-affected populations, creative arts therapies have been associated with reductions in post-traumatic stress symptoms and related psychological trauma symptoms (Schnitzer et al., 2021; Schouten et al., 2014; Wang et al., 2025). These therapies can engage neural pathways related to emotional regulation and cognitive functioning and contribute to improved social reintegration (Bronson et al., 2018; Herman & Chilton, 2023; Vaudreuil et al., 2019). For individuals experiencing prolonged or complex trauma who may not respond fully to conventional treatments, creative arts therapies have been investigated as complementary or alternative interventions (Schnitzer et al., 2021; Schouten et al., 2018).
Evidence also suggests that non-clinical community arts programming, such as participatory theater and group art-making, can support trauma-affected populations (Ackley & Wilson-Menzfeld, 2023; Rose et al., 2018; Rouse et al., 2023). Although the effects of community-based arts engagement on trauma recovery remain less explored, evidence suggests that these interventions can improve several key recovery outcomes, including mental well-being, social connectedness, and self-efficacy.
Arts engagement has been broadly associated with improvements in mental well-being (Bartleet et al., 2023; Crone et al., 2013; Saavedra et al., 2018; Williams et al., 2018). Participation in arts programming may enhance positive affect and support emotional resilience, helping individuals cope with stress (Garner, 2015). For example, group singing within clinical populations has been found to correspond with reductions in negative affect and increases in positive affect, along with measurable changes in stress-related biomarkers (Fancourt et al., 2016). These outcomes serve as protective factors that may contribute to enhanced mental well-being and recovery processes following trauma (Ajdukovic et al., 2013; Straussner & Calnan, 2014; Weber et al., 2025).
Social connection also plays a critical role in trauma recovery by facilitating trust-building and reducing loneliness and social isolation. In some cases, it has been found to moderate the negative effects of post-traumatic stress disorder (PTSD)-related symptoms (Schwartz & Shrira, 2019). Arts engagement is a powerful facilitator of social connection and has been associated with increased community cohesion and social support (Bone et al., 2022; Poulos et al., 2019; Sonke et al., 2025). Engagement in group-based creative practices offers structured, relational environments that encourage interpersonal bonds and shared experiences among participants (Rouse et al., 2023; Giacomucci and Marquit, 2020). Integrating arts-based activities into trauma-informed care can further enhance recovery by promoting a sense of belonging, emotional expression, and mutual support within a safe, communal space (Perkins et al., 2021; Rose et al., 2018).
Self-efficacy, or the belief in one’s capacity to influence life events and overcome challenges, is also central to trauma recovery, where feelings of helplessness and disempowerment are common (Bandura, 1977; Benight & Bandura, 2004). Engagement in the arts has been shown to strengthen self-efficacy (Jensen & Brorsson, 2025; McRae et al., 2018), as well as increase confidence and sense of purpose (Ackley & Wilson-Menzfeld, 2023). By participating in arts activities, receiving validation, and mastering new skills, individuals can restore their sense of control and personal agency, mechanisms that in turn support resilience and recovery following trauma.
Purpose or Aims
The purpose of this study was to explore the impact of community-based arts programming among adults in active recovery from trauma. The study was conducted in collaboration with the International Arts + Mind Lab (IAM Lab) at Johns Hopkins School of Medicine and Path with Art (PwA), a Washington State-based community arts organization that provides arts programming for low-to-no-income adults in active recovery from trauma, including domestic abuse, homelessness, substance use disorder, and mental health challenges. The organization promotes individual and community restoration through creative engagement. While staff and participants have observed these benefits firsthand, this study aimed to formally evaluate the impact of PwA programs on psychosocial outcomes associated with trauma recovery, specifically mental well-being, social connectedness, and self-efficacy. A deeper understanding of how arts programming influences these interconnected outcomes can help substantiate its value as a meaningful and holistic approach to supporting trauma recovery and inform its broader integration into systems of care.
Method
Research Design
This study was guided by an integrated conceptual framework that draws on two complementary models: the Arts and Culture in Public Health Evidence-Based Framework (Golden et al., 2024) and the Impact Thinking Framework (Magsamen et al., 2023).
The Arts and Culture in Public Health Framework offers an evidence-based model for understanding how arts and cultural engagement influences individual and collective health. This framework identifies pathways such as aesthetic experience, meaning-making, and expression as mechanisms for promoting direct health benefits, including well-being and thriving, reduced loneliness and isolation, and enhanced self-efficacy, core outcomes examined in this study. The Impact Thinking Framework guides the study’s approach to translating insights into effective interventions by emphasizing collaboration, iterative learning, and real-world impact. It supports a holistic understanding of how interventions can create sustainable benefits at both individual and community levels, ensuring findings are meaningful and applicable to practice.
Together, these frameworks informed the selection of primary outcome variables, the development of survey and interview instruments, and the study’s convergent parallel mixed-methods design. Quantitative measures were used to assess changes in key recovery outcomes, while qualitative survey responses provided contextual insight into how and why arts engagement may have influenced participants’ recovery experiences. Triangulation across data sources enabled comparison and validation of findings, which helped to strengthen the study’s alignment with both evidence-based inquiry and practice-based impact within community settings.
Study Overview
This 12-month study explored the impact of community-based arts engagement on adults with low-to-no-income in active recovery from trauma. The study utilized pre- and post-intervention surveys to assess outcomes of 8-week classes, incorporating three validated measures. An exit-survey with open-ended questions provided additional insights into the effects of PwA’s programming on participant well-being. The study spanned one full year of programming, consisting of four-individual 8-week sessions (February 2024 to March 2025).
To begin, the research team met with PwA to discuss potential health and well-being outcomes related to trauma recovery. The research team then conducted a brief literature review to identify connections between suggested outcomes, trauma recovery, and the arts. Based on these findings, the study’s targeted outcomes were refined, and validated survey instruments were selected.
The study was reviewed and approved as exempt by the Johns Hopkins School of Medicine Institutional Review Board.
Population
Data were collected from English-speaking participants, aged 18 and older, who were low-to-no-income and in active recovery from trauma. Veterans were also eligible, regardless of income status. Participants were referred to PwA from over 60 social service partners including housing providers, social services, mental health agencies, and veteran organizations. All individuals enrolled in at least one 8-week class with PwA were eligible to participate.
Setting
Classes were held on a quarterly basis throughout the year. Each quarter offered an average of 14 classes for enrollment. Each class met for eight weekly sessions, typically lasting 2 hours. Participants completed at least one class and could enroll in up to two classes per quarter. Offerings included choir, music, dance, theater, writing, poetry, storytelling, podcasting, visual arts, mixed media, and design thinking. Classes were delivered in both virtual and in-person formats. Online classes were conducted via Zoom, while in-person classes were held at PwA and at partner locations throughout Seattle, Washington. Classes were facilitated by teaching artists.
Data Collection
During registration, participants were offered the option to voluntarily opt in to the study. To facilitate data collection, PwA provided the IAM Lab with participant information. The IAM Lab then uploaded the data into Qualtrics and assigned unique identifiers to ensure confidentiality. Pre-surveys were distributed via Qualtrics before classes began, with follow-up reminders sent by the IAM Lab. Post- and exit-surveys were distributed via Qualtrics during the final week of classes.
Pre- and Post-Survey Data Collection
The pre- and post-survey was a 47-question instrument designed to measure changes in participants’ mental well-being, social connectedness, and self-efficacy during the intervention. The survey incorporated three validated tools: the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) (Tennant et al., 2007), the UCLA Loneliness Scale (Version 3; UCLA-LS) (Russell, 1996), and the General Self-Efficacy Scale (GSES)(Schwarzer & Jerusalem, 1995).
Exit-Survey Data Collection
An exit-survey was distributed alongside the post-test at the end of each quarter to evaluate participants’ experiences with PwA programming. The 16-question survey included Likert-type-scale items and open-ended questions to capture participants’ perceptions of the program’s impact on their health and well-being, including why they continue to attend classes each week, how the classes influence key psychosocial outcomes related to trauma recovery, and additional reflections on the program.
Data Analysis
A convergent parallel mixed-methods framework was applied to the design of this study and utilized quantitative and qualitative data. This design provided a comprehensive understanding of the research topic and allowed comparison of datasets for validation. Data from WEMWBS, UCLA-LS, and GSES were compared with exit-survey items, and convergent patterns across both quantitative measures and participant-reported experiences were identified.
Pre- and Post-Survey Data Analysis
Across the study period, class surveys were sent to 590 unique participants. In total, 120 participants completed both pre- and post-surveys. To ensure independence of observations, duplicate responses from participants who completed multiple quarters were identified, and only the first response was included. A total of 80 independent responses were analyzed.
Data were analyzed using descriptive and inferential statistics to examine changes in outcomes over the intervention period. Paired t-tests were used to compare pre- and post-survey responses and determine any significant differences in scores on the WEMWBS, UCLA-LS, and GSES.
Exit-Survey Data Analysis
A total of 103 unique, fully completed exit-surveys were analyzed, regardless of pre- and post-survey completion. If multiple responses from the same participant were identified, only the first response was included to ensure each individual was represented only once. Quantitative data were analyzed using descriptive statistics to identify patterns across key outcomes, while qualitative data were analyzed using a thematic analysis following Braun and Clarke’s (2006) approach. A preliminary codebook was developed by a member of the research team based on the participants’ open-ended responses. The research team was divided into pairs, and each pair independently conducted an initial round of coding. The full team then met to review and refine the codebook to improve consistency. Using the revised codebook, all researchers coded the full dataset, and discrepancies were discussed until consensus was reached. Codes were organized into broader themes, and exemplar quotes were identified for each theme. While survey questions focused on the study’s primary outcomes, codes and themes were derived inductively from participant narratives.
Results
Pre- and Post-Survey Results
Analysis of the combined pre- and post-survey data revealed statistically significant improvements in all three measured areas: Mental Well-being (WEMWBS) showed a significant increase (p < .01); Loneliness (UCLA-LS) showed a significant reduction (p < .01); and Self-Efficacy (10-item GSES) showed an increase (p = .02; Table 1).
Pre- and Post- Survey Results
While overall trends were positive, individual responses varied: some participants showed substantial improvements, others experienced declines, and many had modest changes. This variability suggests that the intervention, along with other influencing factors, had differing effects on participants. Still, the results indicate that PwA classes have a measurable and positive impact on mental well-being, social connectedness, and self-efficacy.
Exit-Survey Results
Quantitative Results
Exit-survey results indicate a positive effect across outcomes related to trauma recovery (Table 2). In total, 90.3% of respondents agreed that classes increased their self-efficacy or belief in their ability to accomplish goals despite difficulties; 88.3% of respondents reported improvements in mental health; 80.6% of respondents agreed that they felt less lonely since joining classes; and 69% of participants indicated they had made new friends in the classes, suggesting improvement in social connection.
Exit Survey Results
Qualitative Results
Analysis of exit-survey narrative data revealed five interconnected themes: social connection and community; mental and emotional well-being; personal growth and empowerment; motivation and purpose; and creative and educational engagement. These themes illustrate the lived experiences of participants.
Social connection and community
The most central theme across responses was the importance of community and connection. The supportive environment of PwA created community and enhanced participants’ sense of belonging and connection. Participants reported feeling seen, heard, and accepted by both peers and instructors, which supported their recovery. One participant wrote, “Through PwA, I get to see familiar and friendly faces on a regular basis around Seattle, which is really helpful in my recovery from Complex PTSD.”
Participants viewed classes as a way to alleviate isolation and provide structure for social interaction. Many shared that their involvement significantly reduced feelings of loneliness through interactions with like-minded people. Classes served as a weekly touchpoint, providing meaningful social connections. One participant wrote “Just going and being at the class took away my loneliness. That would last for the rest of the day.” Several reported forming lasting friendships and using the space to relearn social behaviors: “I attend weekly to retrain my body on what healthy interactions look and feel like.”
Participants also shared that PwA classes provided a safe, inclusive community, where diversity was welcomed. One participant appreciated that “people who are different are not ostracized.” A participant who communicates in American Sign Language (ASL) described making connections with others: “I made a friend and we communicate in ASL. [I don’t] feel as alone.”
Mental and emotional well-being
Participants repeatedly emphasized how engaging in PwA classes helped them navigate trauma, mental health challenges, and daily living. Many described art-making as a way to manage stress, anxiety, and trauma-related symptoms. One participant wrote, “[PwA] helps immensely with anxiety and depression. I don’t feel ‘owned’ by my PTSD when I’m in art classes.” Another echoed that, “PwA has been a HUGE influence on my mental health.”
Participants highlighted the value of creating art in a supportive environment, describing the classes as opportunities for self-care and stress reduction through creative expression. One participant wrote that, “The artwork itself is hugely therapeutic. Art both improves my mood and mental state, and helps me work through issues that I can’t figure out just by talking.” Another said, “The classes and community have become a vital part of my mental health care routine.” Creative engagement was described as a means of emotional processing: “It slowly turned into a visual way of processing my trauma and mental health.”
Participants also described a sense of renewed hope: “In a world so divided, the participants and PwA restored my belief in a better society.” Another wrote, “I never imagined rediscovering my joy by attending classes and healing from my traumas with such a light heart.”
Personal growth and empowerment
Participants reported that their engagement with PwA enhanced confidence, self-efficacy, and personal growth. Many discovered new capacities for creativity and resilience. One shared, “This class showed me how I could make really successful pieces of artwork, even though I’m alone, at home, without much money.”
Many participants shared the importance of engaging in creative activities in an environment that encouraged experimentation without pressure or fear of failure. “Knowing there will be no judgment . . . gave me a sense of progress over perfection,” one participant said. Another added, “I could express my feelings and be creative without being told that I was bad or wrong.” This environment allowed participants to step outside their comfort zones in a safe space.
Growth in self-confidence, self-compassion, and self-awareness was also widely reported. One participant reflected, “I have become more gentle with myself, which allows me to adapt and incorporate the mistakes I make into the meaning of [my] art.” Others noted, “Being guided through that process has been all-important for learning about myself,” and “I am more confident and patient with self and others.” One participant summed up their experience: “PwA gave me my life back. My spark. My love for life . . . I went from caterpillar to butterfly.”
Motivation and purpose
Participants described PwA classes as a vital source of structure in their lives, offering a dependable routine and sense of stability. Regular attendance provided not only an opportunity for creative engagement but also a meaningful commitment that participants could consistently show up for. One shared, “It shows that within a structured framework I can accomplish a lot!” Others said, “Making a commitment to myself and the organization really helps that belief,” and “I want to do something for me, and having a class makes sure that happens.”
Participants also described classes as a lifeline that helped them reconnect with meaning, motivation, and self-worth. For many, the classes became a reason to keep going. As one participant shared, “PwA helps give me a reason to go on and gives me hope that maybe my life might get better some day.” Several participants appreciated the sense of worth and accomplishment: “I have the self-respect of doing something worthwhile and my life is not so empty” and “My confidence, self-worth, and general mental state have improved in huge, lasting ways.”
Creative and educational engagement
PwA was seen as a space for creative exploration and skill-building, offering opportunities to experiment, revisit practices, and build artistic confidence. One participant said, “It saved my pilot light from extinguishing and helped me overcome severe artist block.”
Learning and skill acquisition were other strong motivators: “I attended each week to learn more about watercolor . . . it keeps me out of my head and gives me skills to fall upon.” Others spoke of wanting to “learn new things,” “expand abilities,” and “grow in our skills together.”
Program feedback
Participants expressed deep gratitude for PwA, describing the program as “life-changing,” “stabilizing,” and “profoundly meaningful.” The feedback was overwhelmingly positive, reflecting the strong impact the program has on participants’ lives. While individual responses are not detailed here, all feedback was shared with PwA to support ongoing program development and ensure offerings remain responsive to community needs.
Discussion
This mixed-methods study examined the impact of community-based arts programming on psychosocial outcomes related to trauma recovery through validated survey measures and qualitative participant narratives. Participation was associated with improvements in mental well-being, social connectedness, and self-efficacy. Importantly, the study did not assess trauma-symptom severity, such as PTSD. Rather, trauma recovery was conceptualized through psychosocial outcomes recognized as contributing to recovery processes. Findings should be interpreted as evidence of positive movement within recovery-related domains, not as indicators of clinical recovery or symptom remission, which fall outside of the scope of community-based arts programming.
Quantitative results demonstrated significant improvements in all three outcomes from pre- to post-intervention. Qualitative data provided deeper insight into these outcomes, revealing five interconnected themes. These themes contextualize the quantitative findings, suggesting that participants experienced both measurable and perceived improvements in outcomes related to trauma recovery.
“Social Connection and Community” emerged as the most prominent theme in the narrative data. Participants reported feeling less isolated and more connected and supported within safe class environments, experiences that correspond with observed reductions in loneliness scores. Consistent with existing literature demonstrating that arts engagement can create shared experiences, connection, and belonging among participants (Perkins et al., 2021; Rose et al., 2018; Rouse et al., 2023), these results highlight the potential value of group-based creative activities in promoting health and well-being. These findings further situate the program within broader efforts to address rising loneliness and mental health challenges.
Narrative data also highlighted “Mental and Emotional Well-being” as a key theme, with participants indicating that the classes helped them manage symptoms of anxiety, depression, and post-traumatic stress. Creative engagement functioned as a means of emotional processing and was described as a complement to existing mental health supports. These findings reinforce the positive shifts in mental well-being captured through quantitative measures and align with broader evidence that connects arts engagement with psychological health benefits (Bartleet et al., 2023; Crone et al., 2013; Saavedra et al., 2018; Williams et al., 2018). It is important to note that this study examined non-clinical community arts programming led by teaching artists rather than licensed therapists. While distinct from clinical creative arts therapies and psychotherapy, such programs may complement clinical services when delivered using trauma-informed approaches and in coordination with mental health providers.
Improvements in self-efficacy were reflected across themes of “Personal Growth and Empowerment” and “Motivation and Purpose.” Participants described increased confidence, agency, and belief in their ability to navigate challenges. A structured and non-judgmental environment played a key role in this growth by allowing participants to take creative risks and reframe personal narratives without fear of criticism. Regular weekly engagement provided stability and purpose, while opportunities for skill development and mastery, as discussed in the “Creative and Educational Engagement” theme, may have reinforced participants’ sense of competence. These findings align with prior research demonstrating that arts engagement can strengthen self-efficacy, confidence, and sense of purpose (Ackley & Wilson-Menzfeld, 2023; Jensen & Brorsson, 2025; McRae et al., 2018).
Overall, the qualitative data support the quantitative trends and contextualize participants’ lived experiences, demonstrating how creative engagement in structured, supportive, and collaborative environments may meaningfully contribute to psychosocial health and trauma recovery.
Limitations
Several limitations should be noted. First, the lack of access to paper surveys or loaner devices may have excluded participants without personal technology, potentially reducing survey completion and creating sampling bias. This issue may have disproportionately affected already marginalized groups, ultimately limiting the generalizability of the findings.
Second, although participation was appropriately voluntary, this may have introduced self-selection bias. Participants who felt positively about the program or who had fewer barriers to participation may have been more likely to complete surveys, potentially skewing results toward more favorable outcomes.
Finally, despite overall positive trends, individual responses varied, suggesting effects may differ by engagement level, personal circumstances, and concurrent supports. This study did not control for external variables or additional treatments that participants may have been receiving. While PwA does not provide clinical services, many participants are referred by community partners that do offer such services. Since the study lacked a control group, improvements cannot be solely and definitively attributed to arts programming.
Implications for Research
Future research should account for external variables that may influence outcomes and consider strategies, such as control groups and longitudinal designs, to isolate the unique contribution of arts engagement to health and well-being among individuals recovering from trauma. In addition, studies should incorporate accessible data collection methods and broader recruitment strategies to reduce sampling and self-selection bias and promote more representative participation. These approaches will help address gaps in the literature, as much of the existing research examines arts engagement without clearly isolating its specific effects.
Implications for Practice
For community arts organizations, mental health practitioners, and social service providers, this study offers a case for incorporating arts-based approaches into trauma-informed care. The demonstrated benefits, including improved mental well-being, self-efficacy, and social connectedness, highlight the potential of creative engagement to support recovery in holistic, participant-led ways. These outcomes are achieved outside of formal clinical settings, suggesting that community-driven arts models can complement and extend the reach of traditional therapeutic interventions. Practitioners working with trauma-affected populations, particularly those who face barriers to conventional care, may find arts-based programming a flexible, low-threshold, and culturally responsive option.
Implications for Policy
At the policy level, these findings contribute to the growing recognition of the arts as a critical component of public health infrastructure. As governments and health systems increasingly adopt trauma-informed and preventive approaches to care, there is a clear rationale for funding and supporting community arts initiatives as part of a broader well-being agenda. Policies that promote cross-sector collaboration, between cultural institutions, health agencies, social services, and community organizations, will be essential to embedding arts-based models into local and regional systems of support. Investment in artist training, program evaluation, and sustainable delivery models can strengthen the capacity of community-based arts programs to promote health equity and enhance trauma recovery.
Conclusion
Overall, this study suggests that community-based arts programming is a valuable intervention for individuals in trauma recovery, contributing to improvements in psychosocial outcomes central to recovery. The combination of creative engagement, social support, and personal growth contributes to improved mental and overall well-being. By promoting self-efficacy, reducing feelings of isolation, and offering safe, non-clinical spaces for emotional expression, these programs address key components of trauma recovery in accessible and inclusive ways.
The findings align with broader evidence that community arts initiatives strengthen social cohesion and belonging and build informal support networks, all of which are crucial for sustained recovery and resilience. Arts engagement allows individuals not only to reconnect with themselves but also to feel seen, heard, and valued within a wider social context.
These insights support integrating arts-based approaches within trauma-informed care frameworks and recognizing the arts as a legitimate component of holistic health and social services. Community-driven models offer a flexible, strengths-based complement to clinical interventions, especially for those facing barriers to traditional care.
There is a strong case for further investment in community arts infrastructure, capacity-building for artists and facilitators, and cross-sector collaboration between health, social care, and cultural organizations. Embedding community arts more firmly within local care systems can help ensure that recovery from trauma is not only possible but also grounded in connection, creativity, and collective empowerment.
Footnotes
Authors’ Note:
The authors would like to express our gratitude to the staff and participants of Path with Art for their ongoing support and partnership, as well as acknowledge Dr. Tasha Golden for her contributions at the inception of this project. The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: This study was funded by Path with Art, which was also the subject of the research. The organization’s role was limited to setting the initial research aims and providing participant information to facilitate data collection. The organization had no involvement in study design beyond the initial aims and no role in data collection, analysis, interpretation, or reporting of results. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this project was provided by Path with Art. The study was reviewed and approved as exempt by Johns Hopkins University Institutional Review Board (IRB00406019).
